What a GOP Senate Would Mean for Obamacare

Full repeal is impossible, but the GOP could do some real damage to the Affordable Care Act.

WASHINGTON, DC - OCTOBER 14: (L-R) U.S. Senate Minority Whip Sen. John Cornyn (R-TX), Senate Minority Leader Mitch McConnell (R-KY), and Sen. John Barrasso (R-WY) walk from McConnell's office to the Senate Chamber on October 14, 2013 in Washington, DC. As Democratic and Republican leaders negotiate an end to the shutdown and a way to raise the debt limit, the White House postponed a planned Monday afternoon meeting with Boehner and other Congressional leaders. The government shutdown is currently in its 14th day.  (National Journal)

A Republican Senate majority wouldn't be able to fully repeal Obamacare, but it could force some pretty significant changes to the health care law.

For now, the GOP isn't talking much about what would come after Election Day. Its candidates are falling over themselves to pledge their support for full repeal — which may well be a winning message in a campaign but will be politically impossible even with the Senate majority. After all, President Obama will still be in the White House.

But as the odds of a GOP takeover increase, a rough outline is starting to emerge of how Republicans would handle Obamacare. Full repeal might be a fantasy, but with total control of Congress the GOP might be able to chalk up some real policy wins against the Affordable Care Act, and the first targets are already coming into view.

"The ultimate goal is to fully repeal Obamacare and replace it with commonsense proposals that solve the cost problem. But recognizing that Obama will be president for the next three years, we will use every lever we can in the meantime to lay the groundwork for its repeal," a senior GOP aide said.

Winning the Senate and keeping the House would also have some risks for the GOP. It would step up the pressure to prioritize bills that Obama might sign, without disappointing conservatives who don't want to see the party accept Obamacare as the status quo. And it would bring into sharper relief the constant question of whether Republicans should advance their own health care plans.

Here's how a Republican-controlled Senate's Obamacare strategy would likely play out:

First, expect a vote on full repeal. Republicans will use any procedural opening they can to get a full-repeal bill to Obama's desk, a Republican health care staffer said. Yes, Obama will veto it, and there will be plenty of eye rolling about how many futile repeal votes congressional Republicans have held. But the Senate has never held one, and any Republican who doesn't want to get primaried will want a chance to vote for repeal before moving on to anything that might look like "fixing" Obamacare.

After that, Republicans have two anti-Obamacare tracks — bills that might pass, and bills they could force Obama to veto.

There's some low-hanging fruit that could gain bipartisan support. If Republicans win the Senate, for example, Obama will almost surely be presented with a bill to repeal the health care law's tax on medical devices. That proposal has passed the House and could easily pass the Senate today, with strong bipartisan support — if it ever came up for a binding vote.

The GOP aide laid out a few more items that might win Democratic support, such as repealing the health insurance tax and stepping up the procedures for recapturing improper subsidies. Even a big-ticket item like repealing the employer mandate could attract red-state Democrats, allowing Republicans to argue that they're pursuing bipartisan reforms, even if most or all of their efforts are ultimately vetoed.

Aides also said Republicans will likely force Obama to veto a bill repealing the individual mandate. There's no way he'd ever sign such a bill, but the GOP sees political value in forcing the issue all the way to his desk.

"It's always better to change the law than to force a veto, but on fundamental differences, vetoes can be useful too," said Dean Clancy, a tea-party-aligned policy analyst.

"Recognizing that Obama will be president for the next three years, we will use every lever we can in the meantime to lay the groundwork for its repeal."

(Ironically, it's vulnerable Democrats who are probably most eager to vote for some of these bills. Majority Leader Harry Reid won't call a vote on a device-tax repeal; a Majority Leader Mitch McConnell probably would. And no one would be happier about that vote than Sen. Joe Donnelly, a Democrat from Indiana — a red state with a big device-industry presence.)

But eventually, the decisions for GOP leaders get harder: Do they want to fixate on unpopular parts of Obamacare, essentially using the Senate majority to amplify the message the House has been sending for the past four years? Or would they be better off advancing their own ideas, sending Obama bills that lay out a conservative vision of health care policy, rather than simply chipping away at his vision?

"If Republicans think they're going to win big majorities simply by saying the word 'Obamacare' over and over, I think they're kidding themselves," Clancy said. "To be a governing majority, you have to act like a governing majority."

But taking on a sweeping project to overhaul the whole health care system has its own risks.

Everything in health care policy comes at a cost — lower premiums mean higher deductibles, more doctors mean higher premiums, cost control means Medicare cuts. Any plan is open to attack.

And Clancy, like other conservative activists, would have the GOP take on some of the sacred cows of health care policy — such as the law requiring emergency rooms to treat the uninsured and patient-privacy laws.

That's certainly an affirmative vision, but it's one that would take the party a long way away from the relative safety of simply attacking Obamacare, and Obamacare is what's unpopular. People like the U.S. health care system overall, and as Obamacare has shown, trying to change that system is an extremely hard sell.

"There is something to" that concern, Clancy said."It's a fight against government-run health care and mandates, and not just about Obamacare, but right now they're stymied in fighting Obamacare."